Provider Demographics
NPI:1477122208
Name:LYDIA'S MEDICAL NUTRITION THERAPY
Entity Type:Organization
Organization Name:LYDIA'S MEDICAL NUTRITION THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIETITIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:SIPHIWE
Authorized Official - Last Name:CHOWA
Authorized Official - Suffix:
Authorized Official - Credentials:DRPH, RD, RN
Authorized Official - Phone:951-902-3334
Mailing Address - Street 1:1833 ARBUCKLE WAY
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-1341
Mailing Address - Country:US
Mailing Address - Phone:951-902-3334
Mailing Address - Fax:
Practice Address - Street 1:1833 ARBUCKLE WAY
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-1341
Practice Address - Country:US
Practice Address - Phone:951-902-3334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-24
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty